Provider Demographics
NPI:1629062351
Name:PERSONS, ROBERT KING (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KING
Last Name:PERSONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 STATE HIGHWAY 83
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-3800
Mailing Address - Country:US
Mailing Address - Phone:850-892-8015
Mailing Address - Fax:850-892-8457
Practice Address - Street 1:WALTON COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:3162 HIGHWAY 83
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433
Practice Address - Country:US
Practice Address - Phone:850-892-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4692207Q00000X
FLOS0004692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009198500Medicaid